The purpose of this study was to elucidate whether or not the reduction of lung volume is related to the mechanism of blood flow reduction in the atelectatic lung. In adult mongrel dogs, whose main stem bronchus in the thoracotomized lung was obstructed, the change of blood flow in the lung containing N₂ was compared with that in the collapsed lung.
1) Under a low partial pressure of O₂ in the broncho-alveolar system by obstruction of the main stem bronchus, the blood flow did not change, even when the N₂ volume in the lung was varied. Therefore, the change of blood flow in the collapsed lung is not attributable to the reduction of lung volume.
2) The lung blood flow increased when the partial pressure of O₂ in the broncho-alveolar system was elevated by infusion of O₂ into the collapsed lung, and it decreased with the subsequent O₂ absorption leading to lung collapse. Therefore, the change of lung blood flow is due to the change of intraalveolar partial pressure of O₂.
3) The reduction of blood flow in the atelectatic lung is caused by hypoxic pulmonary vasoconstriction, and is not influenced by the reduction of lung volume due to the lung collapse.

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Continuous changes of respiratory impedance by the oscillation method using Asthograph and ^81mKr ventilation image during saline and sulpyrine solution (100mg/ml, 250mg/ml) provocation were simultaneously measured in 15 adult asthmatics and 7 normal individuals.
Estimation of airway obstruction by respiratory impedance using Astograph was difficult during sulpyrine inhalation, since respiratory impedance increased gradually. In addition to the measurement of respiratory impedance, images of ^81mKr ventilation were also obtained to estimate the regional ventilatory distribution. Estimation of the airway obstruction was easily obtained.
Another advantage of ^81mKr ventilation image is that it can estimate the regional ventilatory distribution. The site of airway obstruction provoked by sulpyrine was observed predominantly in the lower lung field.
The results of our present study were as follows.
1) In 3 patient, increase of respiratory impedance and defect of ^81mKr ventilation image were observed. Two cases in this group were clinically diagnosed as having aspirin-induced asthma.
2) In 7 patients, a defect of ^81mKr ventilation image was observed, but no increase of respiratory impedance was observed. Five cases in this group could not be clinically diagnosed as having aspirin-induced asthma.
3) In 5 patients, neither defect of ^81mKr ventilation image nor increase of respiratory impedance could be detected.
These results suggest that ^81mKr ventilation image on sulpyrine inhalation challenge test is a useful method for evaluating regional ventilatory distribution, but should be further investigated for application to aspirin-induced asthma.

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The efficacy of conventional CT in the diagnosis of pulmonary emphysema (PE) was studied in 122 patients with miscellaneous diseases including 26 patients with PE. The density and the distribution of low attenuation area (LAA) were evaluated by six independent physicians,
Analysis with kappa statistics showed a good inter-observer agreement in the detection of LAA. The grading of LAA correlated well with FEV₁/FVC, DL_CO/V_A, and lung volumes, which indicated that PE could be detected by conventional CT by the evaluation of LAA. The agreement was poor, however, for the detection of low grade LAA and there were some false positives, and there was no specific pattern in the distribution of LAA in PE compared to other pulmonary diseases. We conclude that the evaluation of LAA by conventional CT is simple and effective in the screening of PE.

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Platelet activating factor (PAF) has been suggested to play an important role in the pathogenesis of bronchial asthma.
In the present study, the effect of i. c. administration of asthremedin on bronchial hyperresponsiveness (BHR) induced by i. v. administration of PAF was investigated in guinea pigs. Changes of airway wall thickeness and ratio of bronchial smooth muscle constriction by histamine were calculated from dynamic respiratory resistance. Administration of PAF induced airway wall thickening. The ratio of bronchial smooth muscle constriction by histamine was enhanced by administration of PAF.
Asthremedin did not inhibit airway wall thickening by PAF, but inhibited BHR to histamine induced by PAF.

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Surfactant protein A (SP-A) is known to inhibit surfactant secretion from pulmonary alveolar type II epithelial cells (type II cells). It is unknown whether SP-A acts as an inhibitor in the presence of lipids since SP-A mostly exists complexed with surfactant lipids. In this paper we focused on this issue using purified surfactant, purified SP-A and synthesized lipid liposomes. Surfactant secretion from type II cells was evaluated as TPA-stimulated secretion of radiolabeled lipids. The results demonstrated that 1) the inhibition of lipipd secretion by purified surfactant depended on its lipid components, not on the SP-A component, 2) the inhibitory effect of SP-A purified from surfactant was reversed in the presence of lipid liposomes, and 3) SP-A free from surfactant was unable to inhibit lipid secretion. We conclude from these results that SP-A can potentially inhibit surfactant secretion, but surfactant secretion is mainly regulated by surfactant lipids.

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Six patients (2.7%) developed meningeal carcinomatosis among 207 patients with small cell lung cancer (SCLC) receiving intensive combination chemotherapy. The cumulative probability of developing meningeal carcinomatosis was 2.7% at 3 years and 7.8% at 5 years after diagnosis of SCLC. Pain in legs, gait disturbance, headache, nausea and vomiting were the characteristic symptoms at the onset of meningeal carcinomatosis. Although cytological examination of cerebro-spinal fluid (CSF) was essential for the diagnosis of meningeal carcinomatosis, elevated protein, LDH, CEA and/or NSE concentration and decreased glucose concentration in CSF were also helpful for the diagnosis. For treatment of meningeal carcinomatosis, all patients received intrathecal administration of methotrexate, cytosine arabinoside and/or prednisolone. Additionally, 3 patients received spinal irradiation, and one received cerebro-spinal irradiation. However, only 2 patients responded, and survival was brief ranging from 2 to 38 weeks. Development of meningeal carcinomatosis seems to be a rare event; however, it may be an obstacle to the prolongation of patient survival in the treatment of SCLC.

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Platelet activating factor (PAF) and tumor necrosis factor α (TNF-α) were examined in the bronchoalveolar lavage fluid (BALF) of 21 ARDS patients to clarify the role of these factors in ARDS. Neutrophil percentages and albumin concentrations in the BALF of the ARDS group were markedly elevated compared with those in the control group (p<0.01), showing a significant correlation (r=0.596, p<0.01). PAF was detected in 14 of 19 ARDS patients (237.5±86.0pg/ml) and TNF-α was detected in 7 of 16 ARDS patients (24.9±13.6pg/ml), whereas these factors were not detected in control subjects. Neither PAF nor TNF-α showed a significant correlation with neutrophil percentage, neutrophil number or albumin concentration. They do not seem to be contributing factors to the prognosis of ARDS patients. However the existence of PAF and TNF-α in the BALF of some ARDS patients suggests that they might play a role in the pathogenesis of ARDS.

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To investigate the mechanism of lipopolysaccharide (LPS)-induced endothelial response, we measured the permeability to albumin of cultured pulmonary endothelial cell monolayers. PMA and SC-9, used as activators for protein kinase C (PCK), failed to cause an increase in permeability to albumin. H-7, a potent PKC inhibitor, did not prevent the LPS-induced increase in permeability to albuin. In contrast, H-8, which strongly inhibits cyclic nucleotide-dependent protein kinases, and a calmodulin antagonist prevented the LPS-induced increase in permeability to albumin. These results suggest that calmodulin and protein kinases other than PCK are implicated in the mechanism of LPS-induced increase in permeability to albumin.

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To investigate the clinical course of patients with silicosis receiving home oxygen therapy (HOT), we compared the clinical data of HOT patients with silicosis and those with other respiratory diseases, and of silicotic patients with HOT and those without HOT in our hospital. In 23 (34.3%) of 68 patients receiving HOT the underlying disease was silicosis. This figure differs from recent official statistics in Japan. In the patients with silicosis, the survival rate was lower than that of those with chronic obstructive pulmonary diseases or old pulmonary tuberculosis, but the degree of decrease in PaO₂ was smaller, suggesting that the prognosis of silicotic patients may be mainly related to pulmonary hypertension and cor pulmonare. In silicotic patients, large opacities on chest X-ray were frequently observed in the patients with HOT compared to those without HOT, indicating that the presense of large opacities is an important factor influencing hypoxemia in silicotic patients.

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A 77-year-old man with small cell lung cancer (SCLC) accompanied by polyneuropathy and SIADH is reported. The patient first developed peripheral hyperesthesia and muscle weakness 6 months before admission. He was diagnosed as having SCLC by sputum cytology and supraclavicular lymph node biopsy. On admission, chest radiography and CT scan revealed a mediastinal mass, and the conduction velocity in peripheral nerves was delayed. He was also found to have SIADH, on the basis of an extremely low level of serum Na (114mEq/l) and osmotic pressure (251mOsm/kg) but with normal urinary Na and osmotic pressure. In association with complete disappearance of the mediastinal mass after intensive chemotherapy, SIADH and polyneuropathy also improved remakably. When SCLC relapsed in the abdominal lymph nodes 11 months after complete disappearance of the mediastinal mass, polyneuropathy and SIADH also reappeared. These results indicate that both SIADH and polyneuropathy comprised a paraneoplastic syndrome.

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Two cases of acute eosinophilic pneumonia are described. The patients presented with an acute febrile illness, dry cough, severe hypoxemia and diffuse pulmonary infiltrates. Total cell count and the number of eosinophils were increased in bronchoalveolar lavage fluid. The TBLB specimen showed eosinophilic infiltration of alveolar walls and spaces. Precipitating antibodies against Trichosporon cutaneum and Trichoderma viride were noted in the patients'sera, and environmental provocation tests gave positive results. The clinical features of acute eosinophilic pneumonia resemble those of summer type hypersensitivity pneumonitis. From these results, we consider that there is a certain degree of overlap between the two diseases.

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A 64-year-old male with cavitary bronchial carcinoma underwent right middle and lower lobectomy. The presence of a mural nodule in the cavity suggested that the cancer originated from the bulla wall. Histologically, adenocarcinoma was found to invade the entire cavity wall, and aspergillus was detected in the intracavitary space. Of 6 patients with cavitary bronchiolar carcinoma with intracavitary aspergillosis is reported in Japan including this case, 3 were treated for aspergillus before operation because X-ray had revealed fungus ball shadow.
Although the mechanism by which aspergillus infects patients with cavitary bronchial carcinoma is not precisely known, it is suggested that this type of carcinoma originates from the bulla wall and that there is considerable time for infection with aspergillus to develop.

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A 17-year-old male was diagnosed as having left spontaneous pneumothorax by chest X-ray. Chest CT scan showed a cystic shadow with a thick wall in the left apex. Thoracotomy was performed, and the bleb was resected. Histologically, aspergillus was found in the cavity and the wall of the resected bleb. In this case, we consider that focal aspergillus infection in the bleb caused spontaneous pneumothorax.
In cases of spontaneous pneumothorax in which the bleb wall is thick, the bleb should be evaluated by histological and bacteriological examination.
Such a case has been rarely reported in Japan.

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A 64-year-old male consulted our hospital with a 6-day history of malaise, body temperature to 38°C, anorexia, and light headedness. The chest radiograph showed consolidation in the left lower lung area. Chest CT and ultrasonography revealed left pleural fluid. The pleural fluid was exudative (yellowish in color, protein 3.0g/dl, Rivalta reaction positive, adenosine deaminase 19.4U/L), and had a total cell count of 4.7×10⁶/ml with 45% lymphocytes, 40% histiocytes, and 15% polymorphonuclear leukocytes. He had kept a budgerigar, but we could not isolate Chlamydia from the pleural fluid or the pet bird. Transbronchial lung biopsy from left S¹⁰ revealed an increase of mononuclear leukocytes within the interstitial spaces, and the alveolar spaces contained polymorphonuclear leukocytes, fibrin, and organized alveolar exudate. Bronchoalveolar lavage cellular constituents were 50% lymphocytes, 27% neutrophils, and 23% macrophages. Serologic studies demonstrated C. trachomatis specific IgM antibody titers at 1:20 in a serum sample and at 1:10 in pleural fluid. We report a case of community-acquired pneumonia caused by C. trachomatis diagnosed by serologic studies.

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A 49-year-old woman with acute lymphocytic leukemia (ALL) who had been intermittently treated with chemotherapy during a 3-year period developed cough and expectoration of increasing severity. Chest X-ray film revealed miliary shadows and bilateral hilar enlargement. Milky fluid was obtained by bronchoalveolar lavage. The intensity of these shadows showed temporary decrease, but thereafter progressively increased until the time of the patient's death. Autopsy findings were consistent with pulmonary alveolar proteinosis and systemic aspergillosis.
Secondary alveolar proteinosis is rare, and in most reported cases is associated with hematological malignancy. To our knowledge, only 45 cases in which it was associated with hematological disorders have been reported. The examination of a patient with any hematological disorder, however, should include differential diagnosis of chest X-ray abnormalities to exclude secondary alveolar proteinosis, which can be lethal if left untreated.

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A 27-year-old man suffering from incomplete type of Behçet's disease presented with swelling of the left thigh. Venography showed obstruction of the left femoral vein by thrombus, and he was diagnosed as having deep vein thrombosis of the left femoral vein. The next year, he developed recurrent hemoptysis. Pulmonary angiography showed aneurysm and mural thrombosis of the left pulmonary artery. Fiberoptic bronchoscopy showed a reddish eminence of the left Behçet bronchus, suggestive of broncho-pulmonary artery fistula. After treatment with colchicine, the hemoptysis decreased. We report a very rare case of Behçet's disease presenting with Hughes-Stovin syndrome.

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A 65-year-old woman with stable atopic bronchial asthma received a prescription for timolol maleate eye drops (0.25% solution, one drop twice a day to both eyes) for glaucoma.
On that evening, ten minutes after administration of the first application of timolol, the patient experienced wheeze and slight difficulty in breathing. Within the next ten minutes, her respiration became obviously asthmatic. Her symptoms progressed rapidly. When she arrived at our hospital, reduced respiratory sounds, cyanosis and disturbance of consciousness were observed.
After treatment with aminophyilline, hydrocortisone, epinephrin and oxygen inhalation, her symptoms completely recovered.
In a provocation test, fifteen minutes after application of timolol, wheeze and dyspnea were induced following an increase in respiratory resistance. After the asthma attack, transient hypoxemia, bradycardia and decrease in blood pressure were also observed.

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A case of endobronchial chondroma in a 74-year-old man with atypical mycobacterial infection is reported. Bronchoscopy was performed in order to exclude the possibility of malignancy. At bronchoscopic examination, a hemispherical polypoid tumor with smooth surface was found at the orifice of left B³ and was removed by transbronchial biopsy forceps. Histologically the tumor was composed of cartilage tissue. About 1 year after forceps resection, no growth of the tumor was seen in the left upper lobe bronchus on bronchoscopic examination.
Endobronchial chondroma is relatively rare. We discuss the clinical features of 19 cases of endobronchial chondroma so far reported in Japan, including our case.

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A case is reported of osteosarcoma of the 11th rib in a 38-year-old woman who presented with dry cough and dyspnea due to bloody pleural effusion and the literature on osteosarcoma of the rib in Japan is reviewed. Osteosarcoma was suggested by roentogenologic findings and examination of a percutaneous needle biopsy specimen. Therefore, we administered chemotherapy, but the tumor showed progressive expansion and invasion, causing paraplegia. The patient died on the 282nd day of admission. We performed an autopsy and diagnosed osteosarcoma histologically. The tumor was covered by a hypervascular capsule, suggesting its association with the bloody pleural effusion.
Osteosarcoma of the rib has not been previously reported in association with bloody pleural effusion. Considering the prognosis and characteristics of such tumors, we recommend prompt diagnosis in cases presenting with bloody pleural effusion.

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